综合老年评估在上消化道出血老年患者中的应用价值：一项为期两年的随访研究。
Usefulness of the comprehensive geriatric assessment in older patients with upper gastrointestinal bleeding: a two-year follow-up study.
作者信息
Pilotto Alberto, Ferrucci Luigi, Scarcelli Carlo, Niro Valeria, Di Mario Francesco, Seripa Davide, Andriulli Angelo, Leandro Gioacchino, Franceschi Marilisa
机构信息
Geriatric Unit and Gerontology & Geriatrics Research Laboratories, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
出版信息
Dig Dis. 2007;25(2):124-8. doi: 10.1159/000099476.
BACKGROUND
The potential usefulness of standardized comprehensive geriatric assessment (CGA) in evaluating treatment and follow-up of older patients with upper gastrointestinal bleeding is unknown.
AIM
To evaluate the usefulness of the CGA as a 2-year mortality multidimensional prognostic index (MPI) in older patients hospitalized for upper gastrointestinal bleeding.
MATERIALS AND METHODS
Patients aged > or =65 years consecutively hospitalized for acute upper gastrointestinal bleeding were included. Diagnosis of bleeding was based on clinical and endoscopic features. All patients underwent a CGA that included six standardized scales, i.e., Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith Score (ESS) and Comorbity Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. A MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk, and MPI 3 = severe risk. The predictive value of the MPI for mortality over a 24-month follow-up was calculated.
RESULTS
36 elderly patients (M 16/F 20, mean age 82.8 +/- 7.9 years, range 70-101 years) were included in the study. A significant difference in mean age was observed between males and females (M 80.1 +/- 4.8 vs. F 84.9 +/- 9.3 years; p < 0.05). The causes of upper gastrointestinal bleeding were duodenal ulcer in 38.8%, gastric ulcer in 22.2%, and erosive gastritis in 16.6% of the patients, while 16.6% had gastrointestinal bleeding from unknown origin. The overall 2-year mortality rate was 30.5%. 18 patients (50%) were classified as having a low-risk MPI (mean value 0.18 +/- 0.09), 12 (33.3%) as having a moderate-risk MPI (mean value 0.48 +/- 0.08) and 6 (16.6%) as having a severe-risk MPI (mean value 0.83 +/- 0.06). Higher MPI grades were significantly associated with higher mortality (grade 1 = 12.5%, grade 2 = 41.6%, grade 3 = 83.3%; p = 0.001). Adjusting for age and sex, the prognostic efficacy of MPI for mortality was confirmed and highly significant (odds ratio 10.47, 95% CI 2.04-53.6).
CONCLUSION
CGA is a useful tool for calculating a MPI that significantly predicts the risk of 2-year mortality in older patients with upper gastrointestinal bleeding.
背景
标准化综合老年评估（CGA）在评估老年上消化道出血患者的治疗及随访中的潜在作用尚不清楚。
目的
评估CGA作为老年上消化道出血住院患者2年死亡率多维预后指数（MPI）的作用。
材料与方法
纳入年龄≥65岁因急性上消化道出血连续住院的患者。出血诊断基于临床和内镜特征。所有患者均接受CGA，包括六个标准化量表，即日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、简易便携式精神状态问卷（SPMSQ）、微型营养评定（MNA）、埃克斯顿-史密斯评分（ESS）和共病指数评定量表（CIRS），以及用药史和同居情况信息，共63项。根据综合总分计算MPI，并表示为MPI 1 =低风险，MPI 2 =中度风险，MPI 3 =重度风险。计算MPI对24个月随访期死亡率的预测价值。
结果
36例老年患者（男性16例/女性20例，平均年龄82.8±7.9岁，范围70 - 101岁）纳入研究。观察到男性和女性的平均年龄有显著差异（男性80.1±4.8岁 vs.女性84.9±9.3岁；p < 0.05）。上消化道出血的原因在38.8% 的患者中为十二指肠溃疡，22.2% 为胃溃疡，16.6% 为糜烂性胃炎，而16.6% 的患者出血原因不明。总体2年死亡率为30.5%。18例患者（50%）被归类为低风险MPI（平均值0.18±0.09），12例（33.3%）为中度风险MPI（平均值0.48±0.08），6例（16.6%）为重度风险MPI（平均值0.83±0.06）。较高的MPI等级与较高的死亡率显著相关（1级 = 12.5%，2级 = 41.6%，3级 = 83.3%；p = 0.001）。校正年龄和性别后，MPI对死亡率的预后效力得到确认且具有高度显著性（比值比10.47，95%可信区间2.04 - 53.6）。
结论
CGA是计算MPI的有用工具，并能显著预测老年上消化道出血患者2年死亡风险。
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